Acute Cholecystitis Flashcards
1
Q
ESSENCE
A
Inflammation of gallbladder, caused by blockage of cystic duct preventing it from draining
2
Q
AETIOLOGY
Main causes
A
- Gallstones 95%
- Called calculous cholecystitis
- Can be trapped in neck of gallbladder or cystic duct
- Gallbladder not being stimulated such as patients in ICU
- Other causes called acalculous cholecystitis
3
Q
CLINICAL FEATURES
Presentation
A
- Pain and tenderness
- Right upper quadrant, may radiate to right shoulder
- Fever
- Nausea
- Vomiting
- Tachycardia
- Murphys sign
- Raised inflammatory markers and white blood cells
4
Q
What is Murphys sign
A
- Place hand in right upper quadrant and apply pressure
- Ask patient to take deep breath in
- Gallbladder will move downwards during inspriation and come in contact with hand
- Stimulation of inflammed gallbladder results in acute pain and sudden stopping of inspiration
5
Q
INVESTIGATIONS
First choice
A
- Abdominal US
- Magnetic resonance cholangiopancreatography (MRCP) may be used if US does not show stones
6
Q
Signs of acute cholecystitis on US
A
- Thickened gallbladder wall
- Stones or sludge in gallbladder
- Fluid around gallbladder
7
Q
MANAGEMENT
General principles
A
- Need emergency admission for investigation and management
- Conservative management
- Surgery
8
Q
MANAGEMENT
Conservative
A
- Nil by mouth
- IV fluids
- Antibiotics (as per local guidelines)
- NG tube if required for vomiting
9
Q
MANAGEMENT
Surgical options
A
- Endoscopic retrograde cholangio-pancreatography (ERCP) can be used to remove stones in common bile tract
- Cholecystectomy
10
Q
COMPLICATIONS
A
- Sepsis
- Gallbladder empyema
- Gangrenous gallbladder
- Perforation
11
Q
What is gallbladder empyema
A
Infection tissue and pus collecting in gallbladder
12
Q
Management of gallbladder empyema
A
- IV antibiotics
- Cholecystectomy (removal of gallbladder) or cholecystotomy (drain into gallbladder to drain infected contents)
